Quiz

• Early empiric antibiotic therapy can improve outcome in multiple organ dysfunction syndrome.

• Trauma patients need to have their airway, breathings, circulation, nervous system, and environment evaluated first.

• Patients can die immediately, early in the course of trauma, and late in the course.

• After the primary and secondary surveys, imaging can take place to further evaluate the head, cervical spine, abdomen, and pelvis.

• Simultaneous examination and treatment offer the best chance of survival.

• Trauma patients often need care at a trauma center as these can provide the services a trauma patient needs for definitive care.

1. A patient is seen on the medical ward with new onset hypotension, low body temperature, and changes in mentation. How do you further evaluate this patient?

a. Obtain a CT scan of the head to rule out intracranial pathology.

b. Obtain a bedside radiograph of the chest to rule out pneumonia.

c. Send the patient to the intensive care unit and begin a thorough evaluation for sepsis.

d. Start IV antibiotics and look for a source of infection.

Answer: d. This patient is presenting with all the signs of septic shock. They need intensive care treatment and a thorough workup for sepsis that can only be done in the intensive care unit.

2. You are evaluating a patient for sepsis who is otherwise immunocompetent. Blood cultures are obtained as are cultures of suspected infected areas. How do you further treat the patient?

a. Start them on at least two bactericidal antibiotics while awaiting culture.

b. As the patient is immunocompetent, you can await the culture results before starting the patient on an appropriate antibiotic.

c. Start the patient on a third-generation cephalosporin and await the results of the culture.

d. Start the patient on an intravenous aminoglycoside and await the results of the culture.

Answer: c. An immunocompetent patient with sepsis can be placed on a single agent course of a thirdgeneration cephalosporin while awaiting the results of the culture. An aminoglycoside doesn’t provide adequate coverage, and the patient doesn’t need more than one antibiotic. Antibiotic therapy should start before cultures return.

3. The patient is being treated for sepsis and has not had normal blood pressure readings after fluid resuscitation. How do you respond next?

a. Give the patient intravenous phenylephrine

b. Give the patient intravenous dopamine

c. Give the patient intravenous albumin

d. Give the patient intravenous norepinephrine

Answer: d. The initial treatment of choice if volume resuscitation doesn’t work is to start a vasopressor. The vasopressor that should be tried first is norepinephrine, with the other choices being used only if norepinephrine fails or gives adverse side effects. Intravenous albumin will not restore the blood pressure.

4. You are caring for a patient with multiple end organ failure from serious burns. What organism should you consider if the patient is suspected of having sepsis?

a. Pseudomonas

b. Klebsiella

c. Staphylococcus

d. Streptococcus

Answer: a. The patient is at a high risk of sepsis secondary to pseudomonas because of burns. This patient needs an antimicrobial agent that covers for this in cases of sepsis.

5. You are called to the scene of a motor vehicle accident with one victim. The victim was seatbelted and was involved in a high velocity single car accident. The victim is found pulseless with no cardiac activity and no evidence of external trauma. What injury has the patient likely sustained?

a. Blunt abdominal trauma

b. Head injury

c. Injury to the aorta

d. Cervical spine injury

Answer: c. Patients who die at the scene without evidence of external trauma have generally died from cardiac trauma or trauma to the great vessels. There is no evidence of head trauma as the patient was seat-belted.

6. What is a common cause of late deaths in trauma patients?

a. Hemorrhage of the pelvis

b. Pneumonia

c. Cervical spine injury

d. Open orthopedic injury

Answer: b. Most late deaths from trauma are secondary to an infectious process, such as pneumonia and not from an orthopedic injury or hemorrhage.

7. You are evaluating a trauma patient with an intact airway and normal ventilation who is found to be hypotensive. In managing this, what do you do?

a. Give typed and cross-matched blood as soon as it is available.

b. Place two IVs in two peripheral veins and give Ringer’s Lactate solution until the blood pressure normalizes.

c. Give IV fluids with albumin to diminish the chance of cerebral edema.

d. Place a central line and give IV normal saline until the central venous pressure is normal.

Answer: b. Peripheral lines should be placed and Ringer’s Lactate solution should be given. Blood transfusions take too long and albumin is unnecessary in the early stages of resuscitation. A central line would take too long and is unnecessary unless a peripheral IV cannot be placed.

8. What is the advantage of the ATLS system?

a. It helps get trauma patients to a trauma center faster.

b. It has standardized trauma care for individuals in all parts of the country.

c. It teaches advanced interventional techniques to ambulance personnel.

d. It allows rural victims to have a better chance of survival.

Answer: The main advantage of the ATLS system is that it has standardized trauma care throughout the country so that victims from just about anywhere can receive adequate resuscitative efforts. It does indirectly help rural patients have a better chance of survival.

9. What is the main purpose of doing angiography in a trauma patient?

a. It is the only way that arterial bleeding can be diagnosed.

b. It is a fast way to identify bleeding sources.

c. It can be used along with arterial embolization to control severe bleeding.

d. It can confirm findings seen on an MRI evaluation.

Answer: c. Angiography can be done to identify bleeding sources but it is not very fast and is mainly used when anticipating arterial embolization to control severe bleeding.

10. Which imaging test is usually done first in trauma patients?

a. CT scan of the head

b. CT scan of the cervical spine

c. AP x-ray of the cervical spine

d. PA x-ray of the chest

Answer: d. The first imaging test usually done in cases of trauma involve a PA X-ray of the chest to look for pneumothorax, hemothorax, and placement of tubes and lines.